Recovery Audit Contract OCMP-26-25113 (RAC)

The Maryland Department of Health (MDH or the "Department") is issuing this RFP in order to assist in its mission to reduce Medicaid Improper Payments through the efficient identification of Overpayments, Underpayments, and actions to prevent future Improper Payments for the three (3) hospital provider types identified in Section 2.2.1, Table 2.1.

The State of Maryland, acting through the Department, is soliciting proposals from Offerors with demonstrated experience and expertise performing Audit services to detect improper Medicaid payments. [...] The Contractor shall receive compensation on a contingency fee basis, primarily based on a percentage of the dollars recovered as Provider Overpayments by the Department as quoted in its Financial Proposal.

This is a Small Business Reserve Procurement for which the award will be limited to certified small businesses.

This RFP includes the following tasks:

• Identifying Medicaid claims that contain Underpayments or Overpayments for which payment was made under Title XIX and XXI of the Social Security Act;
• Supporting the Department in preventing future Improper Payments by making recommendations in an Improper Payments prevention plan;
• Providing support to the Department in the hearing process, should any Provider appeal an Underpayment or Overpayment detected by the Contractor; and
• Providing support to the Department in responding to any external audits such as State or federal oversight agencies involving hospitals.

The identification of Underpayments and Overpayments will occur for claims paid under the Maryland Medicaid Fee-For-Service (FFS) for services for which payment is made under Title XIX and Title XXI of the Social Security Act. [...] The Contractor must be able to perform data mining of Medicaid claim information.

The three (3) following hospital Provider types (General In-State, General Out-of-State, and In-State Psychiatric) are to be audited under this Contract.

**Submit** on emma.maryland.gov under Solicitation Number OCMP-26-25113. To submit a proposal, offerors must first register on emma.maryland.gov.

Offerors are required to submit their responses in two separate parts: Volume I - Technical Proposal and Volume II - Financial Proposal. NO pricing information is to be provided in the Technical Proposal.

An overall Minority Business Enterprise (MBE) subcontract participation goal of **14%** has been established. This solicitation includes a Veteran-owned Small Business Enterprise (VSBE) participation Goal of **2%**.

A Contract will be awarded in accordance with the Competitive Sealed Proposals method under COMAR 21.05.03. Multiple or alternate Proposals will not be accepted.

The Contract Term will have three (3) base years beginning August 1, 2027, and two one (1) year option periods.

Contract Type: Indefinite Quantity with Fixed Prices (Fixed Recovery Percentages of 10%).

Scheduled Site Visit: N/A.